Miller Aaron C, Polgreen Linnea A, Cavanaugh Joseph E, Polgreen Philip M
Department of Economics and Business, Cornell College, Mount Vernon, IA.
Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA.
Am J Infect Control. 2016 Jul 1;44(7):825-9. doi: 10.1016/j.ajic.2016.01.006. Epub 2016 Mar 2.
Environmental risk factors for Clostridium difficile infections (CDIs) have been described at the room or unit level but not the hospital level. To understand the environmental risk factors for CDI, we investigated the association between institutional- and individual-level CDI.
We performed a retrospective cohort study using the Healthcare Cost and Utilization Project state inpatient databases for California (2005-2011). For each patient's hospital stay, we calculated the hospital CDI incidence rate corresponding to the patient's quarter of discharge, while excluding each patient's own CDI status. Adjusting for patient and hospital characteristics, we ran a pooled logistic regression to determine individual CDI risk attributable to the hospital's CDI rate.
There were 10,329,988 patients (26,086 cases and 10,303,902 noncases) who were analyzed. We found that a percentage point increase in the CDI incidence rate a patient encountered increased the odds of CDI by a factor of 1.182.
As a point of comparison, a 1-percentage point increase in the CDI incidence rate that the patient encountered had roughly the same impact on their odds of acquiring CDI as a 55.8-day increase in their length of stay or a 60-year increase in age. Patients treated in hospitals with a higher CDI rate are more likely to acquire CDI.
艰难梭菌感染（CDI）的环境风险因素已在病房或科室层面有所描述，但未涉及医院层面。为了解CDI的环境风险因素，我们调查了机构层面和个体层面CDI之间的关联。
我们利用加利福尼亚州医疗保健成本与利用项目的州住院数据库（2005 - 2011年）进行了一项回顾性队列研究。对于每位患者的住院情况，我们计算了与患者出院季度相对应的医院CDI发病率，同时排除每位患者自身的CDI状态。在对患者和医院特征进行调整后，我们进行了汇总逻辑回归分析，以确定因医院CDI率导致的个体CDI风险。
共分析了10329988例患者（26086例病例和10303902例非病例）。我们发现，患者所遇到的CDI发病率每增加一个百分点，CDI的发生几率就会增加1.182倍。
作为一个比较点，患者所遇到的CDI发病率每增加一个百分点，对其感染CDI几率的影响大致等同于住院时间增加55.8天或年龄增加60岁。在CDI发病率较高的医院接受治疗的患者更有可能感染CDI。
